Frontal Assessment Battery as a Useful Tool to Differentiate Mild Cognitive Impairment due to Subcortical Ischemic Vascular Disease from Alzheimer Disease

Abstract

Background: Prominent executive dysfunction can differentiate vascular dementia from Alzheimer disease (AD). However, it is unclear whether the Frontal Assessment Battery (FAB) screening tool can differentiate subcortical ischemic vascular disease (SIVD) from AD at the pre-dementia stage. In addition, the neural correlates of FAB performance have yet to be clarified. Methods: Patients with mild cognitive impairment (MCI) due to SIVD (MCI-V), MCI due to AD (MCI-A), and demographically matched controls completed the Mini-Mental State Examination, Taiwanese FAB (TFAB), Category Fluency, and Chinese Version of the Verbal Learning Test, and underwent magnetic resonance imaging. White matter hyperintensities were rated according to the Scheltens scale. Results: TFAB total scale and its Orthographical Fluency subtest were the only measures that could differentiate MCI-V from MCI-A. Discriminative analysis showed that Orthographical Fluency scores successfully identified 73.2% of the cases with MCI-V, with 85.0% sensitivity. Orthographical Fluency scores were specifically associated with lesion load within frontal periventricular, frontal deep white matter, and basal ganglia regions. Conclusion: The TFAB, and especially its 1-min Orthographical Fluency subtest, is a useful screening procedure to differentiate MCI due to SIVD from MCI due to AD. The discriminative ability is probably due to frontosubcortical white matter pathologies disproportionately involved in the two disease entities.

Cognitive screening instruments to identify vascular cognitive impairment: A systematic review

“…All the studies were conducted in an outpatient setting, where subjects were recruited by convenience or consecutive sampling from those attending geriatric medicine or neurology‐based memory clinics and dedicated referral centres (eg, a National CADASIL clinic), with additional participants including controls obtained from general practice or other community settings such as volunteer groups. Most studies were conducted in Europe (seven studies), with five in Asia, two in North America, and one in South America …”

“…The most commonly studied single‐item instrument was the CDT ( n = 5) with six different scoring systems reported: the Rouleau, Cahn, Babins and the AD Cooperative Study scoring methods, and two versions of the CLOX, ie, CLOX1 (free drawing) and CLOX2 (copying); the CDT was also combined with the MMSE and the CLOX was combined with the Cube Copying Test . Other individual instruments included the TMT (types A and B) (n = 1), tests of delayed recall (n = 3), including the Delayed Memory Index (DMI) subtest from the Repeatable Battery for the Assessment of Neuropsychological Status Update (RBANS), and four tests of verbal fluency: the F‐A‐S Phonemic (letter) Fluency (n = 1), Categorical Fluency (n = 1), the combination of the Controlled Oral Word Association Test (COWAT) and the Rey Auditory Verbal Learning Test (RAVLT) (n = 1), and the Orthographical fluency subtest from the Taiwanese version of the FAB (n = 1) . The longest administration time was for the ACE‐R at 15 minutes and CAB at 20 minutes …”

“…The highest sensitivity reported for a single instrument was the CLOX2 CDT at 93.3%, albeit with a low specificity of 60% . Only one paper examined the accuracy of a CSI, the Taiwanese version of the FAB and its 1‐minute Orthographical Fluency subtest to separate VMCI from MCI due to AD, reporting a sensitivity of 85% and specificity of 62% at a cut‐off of 0.5 out of 3, with a mean age of 68.5 years . A single study investigating the EMR's (derived from the BMET) ability to distinguish VMCI from AD showed that it had good diagnostic accuracy, AUC of 0.82 (95% CI, 0.73‐0.90).…”

Comparisons of Daily Functional Performance and Relevant Factors in Patients with Alzheimer’s Disease and Subcortical Ischemic Vascular Disease

“…Executive function involves manipulation and update of incoming stimuli through working memory [39], and governs tasks that are conducted in a proper sequence by sustaining attention and monitoring feedback [40]. Previous studies have suggested that patients with vascular dementia/SIVD have worse executive function than those with AD [19,41], and that such discernible changes may even be identified during the very early stage [42]. Other studies have suggested that patients with SIVD have greater deficits in working memory and visuomotor speed compared to patients with AD [43].…”

Update on Vascular Cognitive Impairment Associated with Subcortical Small-Vessel Disease

“…In a study operationalizing MCI criteria, non-amnestic single-domain MCI was unexpectedly common and the authors concluded that it may represent a previously unrecognized MCI subtype associated with SSVD [ 108 ]. The Frontal Assessment Battery is a useful tool to differentiate MCI due to SSVD from AD [ 111 ]. The Montreal Cognitive Assessment performed better than the Mini-Mental State Examination to detect MCI-SSVD [ 112 ].…”